Confused patient

Specialties Hospice

Published

Tell me what kind of intervention or words have helped and what your situation has looked like with a confused patient that absolutely refuses to give up control of his/her meds. Tomorrow when I visit I will count his meds and see if he is taking them correctly. Family just now called and said that they *think* patient is taking his decadron 4mg 2-3 times a day when it is ordered to take daily. I"m sure he is taking it more because of pain control. We decreased the decadron and increased alprazolam because he has been manic. Working 18 hours a day out in the machine shed, mowing the yard etc. :uhoh3: Family has their hands FULL! He is on morphine ER 60 mg BID. And then breakthrough morphine IR 1-2 tabs Q4 hours. When I visit he always declines the need to increase his meds and says that his pain is mild.

I will talk to the supervisor, but do you advise me to go in and say "this is how its gonna be" ask him if he trusts my and his doctor's judgement? I could see him getting absolutely irate about this and even combative. He is so terribly independent!! The family has hired 24 hour caregivers for him.

I have offered and pleaded and begged to fill his med boxes weekly for him. He refuses to give up control I believe because he messes around with them. Maybe we could discontinue everything except for comfort and anxiety meds?

Tell me your experiences!!!

Specializes in LTC, Sub-Acute, Hopsice.

Risperdal is not generally covered by hospice. Haldol is, with less side effects.

Actually, Risperdal is covered, but it is the one with less side effects, especially if you need to use it long term. Haldol works best for short times as it works faster, but the chances of nasty effects from it increase with the length of time used.

I had a patient who went bat-crap crazy from decadron. It had worked well for about 3 weeks, decreasing pain to a "0" and stimulating her appetite and for the first time since she had developed agranular necrosis of the jaw and sinus from chemo she was able to actually taste the food. In the span of a weekend, she went from a very nice mild mannered lady to a screaming, stripping casino freak! And the first sign was when she shaved her head, ran out of the house with no pants on yelling at her son that he MUST take her to the casinos in AC! All on 4 mg a day (and no, she had NO history of any psych issues) We used haldol and lorazepam for this lady until the decadron wore off. She never did go all the way back to "normal", and died about a month after the manic episode.

So I am wondering if your patients "manic" behavior is due to self medication with decadron as maybe he realized that is what is making him feel so "good", so if one is good, 3 are better?

*snort* at the decadron story.

Specializes in LTC, Sub-Acute, Hopsice.

"*snort*". ???

As in that is funny or you don't believe my assessment? As I was at my wits end helping the son deal with a mom who had become a raving lunatic, I called Hopsice Pharmacia and spoke to a pharmcist. She stated that decadron could cause that, although it is rare.

It was a laugh snort, auntie. I thought it was funny. And I know it can happen.

+ Add a Comment